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Drugs Excluded from Part D coverage *ONLINE ONLY*

July 2024

By Medicare Rights Center

Note: Prescription drugs used for the above conditions may be covered if they are being prescribed to treat other conditions. For example, a medicine for the relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold—such as shortness of breath from severe asthma—as long as it is approved by the U.S. Food and Drug Administration (FDA) for such treatment.

If your doctor prescribes a non-cancer medication on your plan’s formulary for a reason other than the use approved by the FDA, your drug will probably not be covered unless the use is listed in one of three Medicare-approved drug compendia (medical encyclopedias of drug uses). For fighting cancer, your drug plan will draw from these and additional compendia and peer-reviewed medical literature when deciding whether to cover a drug.

You may also receive a denial from your Part D plan stating that your drug does not meet the FDA’s Drug Efficacy Study Implementation (DESI) standards. DESI evaluates the effectiveness drugs that had been previously approved on safety grounds alone. Drugs that are found to be less than effective by DESI evaluation are excluded from coverage by Part D.

The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.